Neuropsychological disorders

1
Neuropsychological disorders

• Disorders of the nervous system
• 2 main causes
• Progressive neurological illness
• Head injury
• Closed vs. open
• In most cases damage is permanent

2
Testing for neurological damage

• Neuropsyche tests
• Test for functional ability
• Psychomotor tests
• Fingertapping, pegboard
• Memory tests
• WMS
• California Verbal Learning Test
• Visual/Spatial Tests
• Bender-Gestalt
• Executive Functioning
• Stroop
• Wisconsin Card Sort Test
• Trailmaking AB
• Language
• Boston Naming Test

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Stroop

4
Uses of neuropsychological testing

• Comparison with norm
• Comparison with general cognitive ability
• Memory vs. IQ
• Comparison with self across time
• Base ratesee progression of illness

5
Common problem symptoms

• Memory loss (particularly anterograde)
• Speech disturbances
• Aphasia
• Motor symptoms
• Ataxia/apraxia
• dyskinesia
• Hemispheral neglect
• Planning/executive functioning disturbances
• Agnosia/prosopagnosia
• Mood disturbances
• Paranoia in some cases

6
Closed head injuries

• Blunt force trauma injury
• Coup/contra coup injuries
• Hematoma
• Microshear
• Mixed with alcohol

7
Open (Piercing) Head Injuries

• More immediate structural damage
• Partial ablation of brain
• Less risk of hematoma

8
Toxin Exposure

• EtOH
• Karsikoffs syndrome
• Anterograde anmesia/confabulation
• Fine motor tremors/apraxia
• Dyskinesia
• Confusion
• Lead, mercury, other heavy metals, some
  pesticides linked with dementia

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Diseases and brain damage

• Diseases that cause permanent brain damage
  include
• Encephalitis
• Rubella (in mother)
• CMV (in mother)
• HIV
• Syphilis (untreated)
• Polio (almost non-existent in US)
• PKU (and other inherited metabolic diseases)
• Pertussis, measles, mumps, chicken pox carry
  small risks of permanent brain damage
• Any infection resulting in sustained high fever

10
Dementia

• Progressive cognitive decline
• Memory deficit
• Aphasia
• Apraxia
• Paranoia
• Loss of executive functioning
• Progressive drop in IQ

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Alzheimers Disease

• May be cluster of related illnesses
• Causes progressive brain tissue damage
• Most common cause of dementia
• 5-10 year illness span
• Neurofibrillary tangles
• Amyloid plaques
• Cell death in cortex and hippocampus

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Alzheimers Etiology

• High heritability index
• Probably related to problems controlling amyloid
  proteins in brain
• The Nun Study and chromosome 19
• Treatments (no cure)
• Cholinesterase inhibitors
• Prevent breakdown of Acetylcholine
• Aricept, Exelon, liver damage is a risk
• Memantine (Namenda)
• Affects glutamate
• Recently declined by FDA for mild Alzheimers
• Vitamin E

13
Vascular Dementia

• CVA/aneurysm
• Sudden onset
• Hemispheric weakness
• Sudden confusion, numbness, dizziness vision
  problems (1 or both eyes)
• Sudden onset severe headache
• Seizure
• Immediate treatment is key
• Tissue Plasminogen Activator clotbuster
• Prevention anticoagulants
• Warfarin, Heparin common
• Cause birth defects (including MR)
• If hemorrhagic stroke occurs, can make it worse
• Symptoms recovery in short term

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Carotid Occlusion

• Stenosis of internal carotid arteries
• Waxing and waning periods of dementia
• More treatable than other dementias
• Intracranial bypass Surgery

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Parkinsons Disease

• Progressive decline of dopamineurgic centers
• Gait problems
• Initiation of movement
• Dementia in some cases
• L-Dopa

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Multiple Sclerosis

• Cluster of illnessesall involve demyelization
• Genetic, autoimmune, toxin exposure
• Measles, herpes, chlamydia
• Symptoms weakness, confusion, memory loss,
  numbness, pain, dizziness, fatigue
• Relapsing-remitting type
• Treatment no sure. Common treatments include
  interferon-based agents (Avonex, Betaserone)
• Viral replication interference agents
• Can cause depression, anemia, liver damage, heart
  problems, thyroid damage